Skip to main content

Advertisement

SpringerLink
Log in

A large sample-sized study on dental development of children treated at the Central Dental Clinic (OCEx) of the Brazilian Army

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

To test and compare the performance of two radiographic methods for dental age estimation on a large sample of Brazilian boys and girls.

Material and methods

The sample consisted of 1.990 panoramic radiographs of Brazilian children (age: 3–15.9 years) equally balanced based on sex. The sample was distributed into ten age categories, each with up to 200 children. Age estimation was performed with Willems’ (2001) and Demirjian’s (1973) methods. Estimated (EA) and chronological (CA) ages were compared. The performances of the methods were quantified based on sex and age category.

Results

The overall differences between CA and EA for Willems’ method in boys and girls were 0.06 and − 0.02, respectively. For Demirjian’s method, the differences were 0.60 and 0.74, respectively. The overestimations of Demirjian’s method were statistically significant (p < 0.001). Willems’ method reached the best outcomes among children between 3 and 12 years, while Demirjian’s best performances were between the ages of 7 and 10 years.

Conclusion

Willems’ method led to differences between CA and AE that were acceptable for clinical and forensic practice.

Clinical relevance

Age estimation may guide clinical decisions based on treatment timing. Validating international tools is necessary to promote evidence-based practice and country-specific application. This study overcame the limitations of previous research to provide a more realistic perspective of the performance of age estimation methods in Brazilian children. Willems’ method had a superior performance compared to Demirjian’s method and led to outcomes that were better than most studies with the Brazilian population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Possagno LP, Franco A, Paranhos LR, Grando LJ, De Lima AAS, Bezerra ISQ, Fernandes A (2018) Morphological analysis of the skeletal development in lateral cephalometric radiographs of HIV infected children ongoing Highly Active Antiretroviral Therapy. Med Oral Patol Oral Cir Bucal 23:e691-697. https://doi.org/10.4317/medoral.22610

    Article  PubMed  PubMed Central  Google Scholar 

  2. Pinchi V, Bianchi I, Pradella F, Vitale G, Focardi M, Tonni I, Ferrante L, Bucci A (2021) Dental age estimation in children affected by juvenile rheumatoid arthritis. Int J Legal Med 135:619–629. https://doi.org/10.1007/s00414-020-02395-w

    Article  PubMed  Google Scholar 

  3. Aguiar LBV, Caldas MP, Haiter Neto F, Ambrosano GMB (2013) A methodology to measure cervical vertebral bone maturation in a sample from low-income children. Braz Dent J 24:30–34. https://doi.org/10.1590/0103-6440201301787

    Article  PubMed  Google Scholar 

  4. Bittencourt MV, Cericato G, Franco A, Girão R, Lima APB, Paranhos L (2018) Accuracy of dental development for estimating the pubertal growth spurt in comparison to skeletal development: a systematic review and meta-analysis. Dentomaxillofac Radiol 47:20170362. https://doi.org/10.1259/dmfr.20170362

    Article  PubMed  PubMed Central  Google Scholar 

  5. Cericato GO, Franco A, Bittencourt MA, Nunes MA, Paranhos LR (2016) Correlating skeletal and dental developmental stages using radiographic parameters. J Forensic Leg Med 42:13–18. https://doi.org/10.1016/j.jflm.2016.05.009

    Article  PubMed  Google Scholar 

  6. Franco A, Vetter F, Coimbra EF, Fernandes A, Thevissen P (2020) Comparing third molar root development staging in panoramic radiography, extracted teeth, and cone beam computed tomography. Int J Legal Med 134:347–353. https://doi.org/10.1007/s00414-019-02206-x

    Article  PubMed  Google Scholar 

  7. Sartori V, Franco A, Linden MS, Cardoso M, Castro D, Sartori A, Silva C, Trentin M, De Carli JP (2021) Testing international techniques for the radiographic assessment of third molar maturation. J Clin Exp Dent 13:e1182-1188. https://doi.org/10.4317/jced.58916

    Article  PubMed  PubMed Central  Google Scholar 

  8. Franco RPAV, Franco A, Turkina A, Arakelyan M, Arzukanyan A, Velenko P, Bortolami PB, Makeeva I, da Silva RHA (2021) Radiographic assessment of third molar development in a Russian population to determine the age of majority. Arch Oral Biol 125:105102. https://doi.org/10.1016/j.archoralbio.2021.105102

    Article  PubMed  Google Scholar 

  9. Adserias-Garriga J, Thomas C, UBelaker DH, Zapico SC (2018) When forensic odontology met biochemistry: Multidisciplinary approach in forensic human identification. Arch Oral Biol 87:7–14. https://doi.org/10.1016/j.archoralbio.2017.12.001

    Article  PubMed  Google Scholar 

  10. Vodanović M, Dumančić J, Galić I, Savić Pavičin I, Petrovečki M, Cameriere R (2011) Brkić H (2011) Age estimation in archaeological skeletal remains: evaluation of four non-destructive age calculation methods. J Forensic Odontostomatol 29:14–21

    PubMed  PubMed Central  Google Scholar 

  11. Matteussi GT, Jacometti V, Franco A, Silva RHA (2022) Age estimation in humans through the analysis of aspartic acid racemization from teeth: A scoping review of methods, outcomes, and open research questions. Forensic Sci Int 331:111154. https://doi.org/10.1016/j.forsciint.2021.111154

    Article  PubMed  Google Scholar 

  12. Adserias-Garriga J (2019) Age estimation: a multidisciplinary approach. Academic Press, London

    Google Scholar 

  13. Elamin F, Liversidge H (2013) Malnutrition has no effect on the timing of human tooth formation. PLoS ONE 8:e72274. https://doi.org/10.1371/journal.pone.0072274

    Article  PubMed  PubMed Central  Google Scholar 

  14. Fanning EA (1962) Effect of extraction of deciduous molars on the formation and eruption of their successors. Angle Orthodont 32:44–53. https://doi.org/10.1043/0003-3219(1962)032%3C0044:EOEODM%3E2.0.CO;2

    Article  Google Scholar 

  15. Bezerra ISQ, Topolski F, França SN, Brucker MR, Fernandes A (2015) Assessment of skeletal and dental ages of children and adolescents with type 1 Diabetes Mellitus. Braz Oral Res 29:1–5. https://doi.org/10.1590/1807-3107BOR-2015.vol29.0025

    Article  Google Scholar 

  16. Moorrees CF, Fanning EA, Hunt E Jr (1963) Age variation of formation stages for ten permanent teeth. J Dent Res 42:1490–1502. https://doi.org/10.1177/00220345630420062701

    Article  PubMed  Google Scholar 

  17. Nolla CM (1960) The development of the permanent teeth. J Dent Child 27:254–266

    Google Scholar 

  18. Nicodemo RA, Moraes LC, Médici FE (1974) [Tabela cronológica da mineralização dos dentes permanentes entre brasileiros]. Rev Fac Odont São José dos Campos 3:55–56. [Portuguese]

  19. Roberts GJ, Parekh S, Petrie A, Lucas VS (2008) Dental age assessment (DAA): a simple method for children and emerging adults. Br Dent J 204:E7. https://doi.org/10.1038/bdj.2008.21

    Article  PubMed  Google Scholar 

  20. Anderson DL, Thompson GW, Popovich F (1976) Age of attainment of mineralization stages of the permanent dentition. J Forensic Sci 21:191–200

    Article  Google Scholar 

  21. Cameriere R, Ferrante L, Cingolani M (2006) Age estimation in children by measurement of open apices in teeth. Int J Leg Med 120:49–52. https://doi.org/10.1007/s00414-005-0047-9

    Article  Google Scholar 

  22. Demirjian A, Goldstein H (1976) Ann Hum Biol 3(5):411–21. https://doi.org/10.1080/03014467600001671

    Article  PubMed  Google Scholar 

  23. Demirjian A, Goldstein H, Tanner JM (1973) A new system of dental age assessment. Hum Biol 45:211–227

    PubMed  Google Scholar 

  24. AlQahtani SJ, Hector MP, Liversidge HM (2010) Brief communication: The London atlas of human tooth development and eruption. Am J Phys Anthropol 142(3):481–490. https://doi.org/10.1002/ajpa.21258

    Article  PubMed  Google Scholar 

  25. Thevissen P, Fieuws S, Willems G (2011) Third molar development: Measurements versus scores as age predictor. Arch Oral Biol 56:1035–1040. https://doi.org/10.1016/j.archoralbio.2011.04.008

    Article  PubMed  Google Scholar 

  26. Eid RMR, Simi R, Friggi MNP, Fisberg M (2002) Assessment of dental maturity of Brazilian children aged 6 to 14 years using Demirjian’s method. Int J Paediatr Dent 12:423–428. https://doi.org/10.1046/j.1365-263x.2002.00403.x

    Article  PubMed  Google Scholar 

  27. De Donno A, Angrisani C, Mele F, Introna F, Santoro V (2021) Dental age estimation: Demirjian’s versus the other methods in different populations. A literature review. Med Sci Law 61:125–129. https://doi.org/10.1177/0025802420934253

    Article  PubMed  Google Scholar 

  28. Han MQ, Chu G, Chen T, Zhou H, Guo YC (2019) Research progress of age estimation based on the Demirjian’s method. Fa Yi Xue Za Zhi 35:737–743. https://doi.org/10.12116/j.issn.1004-5619.2019.06.017

    Article  PubMed  Google Scholar 

  29. Fei Y, Yang L, Sheng K, LAi G, Wang J (2021) Dental maturation in a Chinese sample using Demirjian method. Ann Human Biol 48:393–399. https://doi.org/10.1080/03014460.2021.1988705

    Article  Google Scholar 

  30. Lan LM, Yang ZD, Sun SL, Wen D, Kureshi A, Zeye MMJ, Zha L, Li M (2019) Application of Demirjian’s and Cameriere’s method in dental age estimation of 8–16 year old adolescents from Hunan Han nationality. Fa Yi Xue Za Zhi. 35:406–410. https://doi.org/10.12116/j.issn.1004-5619.2019.04.005

    Article  PubMed  Google Scholar 

  31. Esan TA, Yengopal V, Schepartz LA (2017) The Demirjian versus the Willems method for dental age estimation in different populations: A meta-analysis of published studies. PLoS One 12:e0186682. https://doi.org/10.1371/journal.pone.0186682

    Article  PubMed  PubMed Central  Google Scholar 

  32. Willems G, Van Olmen A, Spiessens B, Carels C (2001) Dental age estimation in Belgian children: Demirjian’s technique revisited. J Forensic Sci 46:893–895

    Article  Google Scholar 

  33. Yusof MYPM, Mokhtar IW, Rajasekharan S, Overholser R, Martens L (2017) Performance of Willem’s dental age estimation method in children: A systematic review and meta-analysis. Forensic Sci Int 280:1-245.e10. https://doi.org/10.1016/j.forsciint.2017.08.032

    Article  Google Scholar 

  34. Sehrawat JS, Singh M (2017) Willems method of dental age estimation in children: A systematic review and meta-analysis. J Forensic Leg Med 52:122–129. https://doi.org/10.1016/j.jflm.2017.08.017

    Article  PubMed  Google Scholar 

  35. Wang J, Ji F, Zhai Y, Park H, Tao J (2017) Is Willems method universal for age estimation: A systematic review and meta-analysis. J Forensic Leg Med 52:130–136. https://doi.org/10.1016/j.jflm.2017.09.003

    Article  PubMed  Google Scholar 

  36. Franco A, Oliveira MN, Vidigal MTG, Blumenberg C, Pinheiro AA, Paranhos LR (2021) Assessment of dental age estimation methods applied to Brazilian children: a systematic review and meta-analysis. Dentomaxillofac Radiol 50:20200128. https://doi.org/10.1259/dmfr.20200128

    Article  PubMed  PubMed Central  Google Scholar 

  37. Franco A, Thevissen P, Souza PHC, Fieuws S, Willems G (2013) Applicability of Willems model for dental age estimations in Brazilian children. Forensic Sci Int 231:401.e1-401.e4. https://doi.org/10.1016/j.forsciint.2013.05.030

    Article  Google Scholar 

  38. Fritola M, Fujikawa AS, Ferreira FM, Franco A, Fernandes A (2015) Estimativa de idade dental em criancas e adolescentes brasileiros comparando os metodos de Demirjian e Willems. Rev Bras Odontol Legal RBOL 2:26–34. https://doi.org/10.21117/rbol.v2i1.18 ([Portuguese])

    Article  Google Scholar 

  39. Machado ALR, Borges BS, Cameriere R, Machado CEP, Silva RHA (2020) Evaluation of Cameriere and Willems age estimation methods in panoramic radiographs of Brazilian children. J Forensic Odontostomatol 38:8–15

    PubMed Central  Google Scholar 

  40. Gonçalves LS, Machado ALR, Gaeta-Araujo H, Recalde TSF, Oliveira-Santos C, Silva RHA (2021) A comparison of Demirjian and Willems age estimation methods in a sample of Brazilian non-adult individuals. Forensic Imag 25:200456. https://doi.org/10.1016/j.fri.2021.200456

    Article  Google Scholar 

  41. Souza RB, Assunção LRS, Franco A, Zaroni FM, Holderbaum RM, Fernandes A (2015) Dental age estimation in Brazilian HIV children using Willems’ method. Forensic Sci Int 257:e1-510.e4. https://doi.org/10.1016/j.forsciint.2015.07.044

    Article  Google Scholar 

  42. Gabardo G, Maciel JVB, Franco A, Lima AAS, Costa TRF, Fernandes A (2020) Radiographic analysis of dental maturation in children with amelogenesis imperfecta: A case-control study. Spec Care Dent 40:267–272. https://doi.org/10.1111/scd.12456

    Article  Google Scholar 

  43. Rocha LT, Ingold MS, Panzarella FK, Santiago BM, Oliveira RN, Bernardino IM, Makeeva I, Junqueira JLC, Franco A (2022) Applicability of Willems method for age estimation in Brazilian children: performance of multiple linear regression and artificial neural network. Egyp J Forensic Sci 12:9. https://doi.org/10.1186/s41935-022-00271-9

    Article  Google Scholar 

  44. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative (2008) The Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61:344–349. https://doi.org/10.1016/j.jclinepi.2007.11.008

    Article  Google Scholar 

  45. Vasconcelos KF, Nicolielo LFP, Nascimento MC, Haiter-Neto F, Bóscolo FN, Van Dessel J, EzEldeen M, Lambrichts I, Jacobs R (2015) Artefact expression associated with several cone-beam computed tomographic machines when imaging root filled teeth. Int Endod J 48:994–1000. https://doi.org/10.1111/iej.12395

    Article  PubMed  Google Scholar 

  46. Nascimento EHL, Gaêta-Araujo H, Vasconcelos KF, Freire BB, Oliveira-Santos C, Haiter-Neto F, Freitas DQ (2018) Influence of brightness and contrast adjustments on the diagnosis of proximal caries lesions. Dentomaxillofac Radiol 47:20180100. https://doi.org/10.1259/dmfr.20180100

    Article  PubMed  PubMed Central  Google Scholar 

  47. Altalie S, Thevissen P, Fieuws S, Willems G (2014) Optimal dental age estimation practice in United Arab Emirates’ children. J Forensic Sci 59:383–385. https://doi.org/10.1111/1556-4029.12351

    Article  PubMed  Google Scholar 

  48. Yusof MYPM, Thevissen PW, Fieuws S, Willems G (2014) Dental age estimation in Malay children based on all permanent teeth types. Int J Legal Med 128:329–333. https://doi.org/10.1007/s00414-013-0825-8

    Article  PubMed  Google Scholar 

  49. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  Google Scholar 

  50. Szklo M, Nieto FJ (2018) Epidemiology beyond the basis, 4th edn. Jones and Bartlett Publishers, Burlington p 578

  51. Greulich WW, Pyle SI (1950) Radiographic atlas of skeletal development of the hand and wrist. Stanford University Press, Stanford

    Google Scholar 

  52. Eklöf O, Ringertz H (1967) A method for assessment of skeletal maturity. Ann Radiol 10:330–336

    PubMed  Google Scholar 

  53. Tanner JM, Whitehouse RH, Healy MJR (1962) A new system for estimating skeletal maturity from the hand and wrist, with standards derived from a study of 2600 healthy british children. International Children’s Centre, Paris

    Google Scholar 

  54. Hassel B, Farman AG (1995) Skeletal maturation evaluation using cervical vertebrae. Am J Orthod Dentofacial Orthop 107:58–66. https://doi.org/10.1016/s0889-5406(95)70157-5

    Article  PubMed  Google Scholar 

  55. Baccetti T, Franchi L, McNamara JA Jr (2005) The cervical vertebral maturation (CVM) method for the assessment of optimal treatment timing in dentofacial orthopedics. Semin Orthod 11:119–129. https://doi.org/10.1053/j.sodo.2005.04.005

    Article  Google Scholar 

  56. Seedat AK, Forsberg CD (2005) An evaluation of the third cervical vertebra (C3) as a growth indicator in Black subjects. SADJ 60(156):158–160

    Google Scholar 

  57. Liliequist B, Lundberg M (1971) Skeletal and tooth development – a methodologic investigation. Acta Radiol Diagn 11:97–112

    Article  Google Scholar 

  58. Mörnstad H, Staaf V, Welander U (1994) Age estimation with the aid of tooth development: a new method based on objective measurements. Scand J Dent Res 102:137–143. https://doi.org/10.1111/j.1600-0722.1994.tb01169.x

    Article  PubMed  Google Scholar 

  59. Haavikko K (1974) Tooth formation age estimated on a few selected teeth – a simple method for clinical use. Proc Finn Dent Soc 70:15–19

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Central Dental Clinic (OCEx), Rio de Janeiro, Brazil

    Marcos Vinicius Fernandes Machado

  2. Division of Oral Radiology, Faculdade Sao Leopoldo Mandic, Campinas, Brazil

    Marcos Vinicius Fernandes Machado, Mariana Quirino Silveira Soares & Jose Luiz Cintra Junqueira

  3. Division of Forensic Dentistry, Faculdade Sao Leopoldo Mandic, Campinas, Brazil

    Andrea Maia Sampaio Alonso Baz & Ademir Franco

  4. Centre of Forensic and Legal Medicine and Dentistry, University of Dundee, Dundee, UK

    Ademir Franco

Authors
  1. Marcos Vinicius Fernandes Machado
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mariana Quirino Silveira Soares
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrea Maia Sampaio Alonso Baz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jose Luiz Cintra Junqueira
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ademir Franco
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ademir Franco.

Ethics declarations

Ethics approval

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed. Ethical approval was obtained from the Ethics Committee of Human Research of Faculdade Sao Leopoldo Mandic, Brazil (protocol number: 43741421.0.0000.5374).

Informed consent

For this type of study (observational with retrospective data collection from existing databases), informed consent is not required.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 32 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Machado, M.V.F., Soares, M.Q.S., Baz, A.M.S.A. et al. A large sample-sized study on dental development of children treated at the Central Dental Clinic (OCEx) of the Brazilian Army. Clin Oral Invest 26, 5439–5447 (2022). https://doi.org/10.1007/s00784-022-04511-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-022-04511-z

Keywords

Search

Navigation